Thursday, 28 December 2017

So that was 2017. I didn't quite live up to the heights of 2016 but it still provided some memorable moments. From the perspective of personal liberty, it was pretty dire, but things picked up nicely in December.

If you want to know why I'm looking forward to 2018, read my Spiked article. In the meantime, here are some of the highlights and lowlights of 2017.

Wednesday, 27 December 2017

According to the Daily Mail, Public Health England (PHE) are ending the year by lying with guidelines. Not alcohol this time, but calories...

Britons are being urged to cut their meals to just 1,600 calories a day and 200 calories for snacks in tough new health guidelines.

They will be told they should limit themselves to 400 calories for breakfast, 600 for lunch and 600 for dinner.

This comes to 1,600 calories, well below the current recommended daily intake of 2,000 calories for women and 2,500 for men. Those who exercise regularly can have even more.

Assuming that this is true, it will be interesting to see what evidence - if any - PHE provides for this new edict. They will struggle to find any because there is none. The existing guidelines are broadly correct. If the average person consumed 1,600 calories they would lose weight rapidly and would become malnourished within a relatively short period of time.

How do we know how many calories people need to maintain a healthy weight? One way is to monitor individuals using doubly labelled water. Another way is to look at what the government gives people when they are under its direct command. Soldiers in the British army are given a ration of 4,000 calories a day, for example, although these people are admittedly highly physically active.

The virtual absence of obesity in the mid-20th century when people were consuming around 3,000 calories a day is evidence that we have become less physically active in the meantime, but have we become so sedentary that we only need to eat half as many calories as we did under rationing and a third less than a prisoner?

No. This seems to be a case of PHE deliberately giving people false information with the intention of tricking them into eating less, based on the assumption that we underestimate how much we eat, even to ourselves. The idea is that if you tell people to eat 1,600 calories, perhaps they will eat 2,300 calories. If you tell people to drive at 20mph, perhaps they'll drive at 30mph. If you tell people it's unsafe to drink more than 14 units of alcohol, perhaps they'll only drink 21 units.

There is no doubt that many people underestimate their calorie and alcohol intake, but that is no justification for PHE lying to us. People will not come to any harm if they restrict their alcohol consumption to 14 units a week. They will come to harm if they consume 1,600 calories a day. This is totally unscientific and highly irresponsible advice (think of the anorexics, for example). PHE are no longer pretending to be a source of accurate advice. They are in the business of nudging, manipulation and deliberate deceit.

But there is something else going on here.

The new calorie guidelines – the One You nutrition campaign – will be rolled out by PHE in March, and adults will be told to remember the ‘400-600-600’ rule.

PHE officials are in talks with coffee shop chains and supermarkets to promote healthy breakfast and lunch options within the limit.

The idea of having 'limits' for individual meals is entirely new and I suspect that there is an agenda at work here. The 400-600-600 'rule' will allow PHE and its army of scolds to name and shame every restaurant portion, takeaway and ready meal that contains more than the government-approved quantity of calories. Individual meals will be portrayed as hazardous per se and will become targets for advertising bans, taxes and reformulation. A whole Pandora's Box is being quite deliberately opened.

Having read the judgement (and the press summary), the essence of the case is that Paul Black, a sex offender serving an indeterminate sentence, wants access to the NHS Smoke-free Compliance phoneline so that he can report his fellow inmates for smoking in the common areas of his prison where smoking is banned.

This was granted in January 2014 but the government responded by saying this...

“Part 1 of the Health Act does not bind the Crown. Accordingly, the Secretary of State is of the view that Local Authorities (including on reference by the Compliance Line) have no statutory role in relation to the enforcement of smoke-free provisions at HMP Wymott.”

Black took his case to a judicial review, which he won. The government then took it to the court of appeal where they won. Finally it ended up at the Supreme Court.

In her judgement, Lady Hale goes through the history of the smoking ban from its initial proposal in 2004 to the present day. She says, rightly, that at no point did the government ever imply that it would not apply to state property. On the contrary, it strongly implied that it would.

Some strong points can be made in favour of the conclusion that Parliament did indeed mean the Crown to be bound by the smoking ban. Although the government announced an intention to bring in a ban before the legislation was passed, there is no hint in the government publications leading up to the adoption of the policy that the Crown would not be bound by the legislation when it came into force (other than the exchange with the Health Committee referred to at para 14 above). If this had been made clear, one might have expected the anti-smoking campaigners and the trade unions and staff associations protecting the interests of civil servants and others working for the government to say something about it.

She then says:

Not surprisingly, perhaps, Her Majesty’s Prison Service took the view that the smoking ban did apply to them.

(Note that we are only talking about common areas of prisons. The 2006 Act expressly exempted prison cells.)

However, regardless of what the government implied or intended, it is the letter of the law that counts. By convention, laws do not bind the Crown unless they explicitly say so, and the Health Act 2006 does not say so.

The classic and conventional statement of principle is that a statutory provision does not bind the Crown save by express words or “necessary implication”.

She then gives some case studies and discusses the legal debate around this issue, before concluding...

Had Parliament intended Part 1 of Chapter 1 of the 2006 Act to bind the Crown, nothing would have been easier than to insert such a provision into that Part. It would have made clear who could be prosecuted for the offences created.

... It might well be thought desirable, especially by and for civil servants and others working in or visiting government departments, if the smoking ban did bind the Crown. But the legislation is quite workable without doing so.

... Thus, not without considerable reluctance, I am driven to the conclusion that this appeal must fail. There is a presumption that Acts of Parliament only bind the Crown by express words or necessary implication.

Amusing as this all is, the case has clearly been won on a technicality. Presumably, the government will act in the new year to amend the legislation and take us back to where we thought we were before. Meanwhile, all the smoking bans on government property are essentially voluntary. You can, I assume, be kicked out of the building for breaking the rules, but you cannot be charged with an offence.

Lady Hale helpfully explains the difference between a voluntary smoking ban on crown property and a legal ban...

There are very significant differences between a smoking ban voluntarily imposed by an occupier or employer and the smoking ban imposed by the Act:

(i) The signs displayed have to say that “it is against the law” to smoke in these premises.

(ii) The occupier or manager is guilty of a criminal offence if such signs are not displayed.

(iii) It is a criminal offence to smoke in smoke-free premises.

(iv) The manager has to take reasonable steps to stop people smoking and
is guilty of a criminal offence if he or she does not.

(v) Environmental health officers can be called in to enforce the ban, either against smokers, or against occupiers and managers, or both.

(vi) Environmental health officers have powers of entry to enable them to do so.

(vii) Individual non-smokers who complain about breaches of the ban do not have to bear the expense and burden of bringing proceedings to enforce it.

None of this applies to a ban voluntarily imposed in government premises. Any signs displayed cannot say that smoking is “against the law”. The ban is not backed up by criminal sanctions against smokers or managers. It is not backed up by the enforcement powers of environmental health officers. The only method of challenging a refusal to impose or to enforce a smoking ban would be to bring judicial review proceedings. It is unrealistic to expect workers and members of the public who are adversely affected by exposure to second-hand smoke in government premises to bring judicial review proceedings. These are expensive, time-consuming and inaccessible to most people, nor will they necessarily produce a remedy which is anything like as effective as the statutory enforcement process.

The case raises several questions, not least about why the government appealed this in the first place. Even if they were technically correct - as it turned out they were - what did they have to gain from it? And why haven't lawyers used this argument before when challenging smoking bans in prisons and psychiatric hospitals? Moreover, why aren't smoking bans not being enforced in the common areas of prisons in the first place? How hard can it be?

There is also the question of what happens to all the convictions for smoking on government property that have been amassed over the last ten years. Are they now unsafe? I assume they are. In which case, are those who have been fined due compensation?

Finally, what about all the government buildings that are covered in false warnings about smoking being illegal on the premises? Are there laws or departmental codes designed to prevent government agencies misleading the public in this way? I think we should be told.

Tuesday, 19 December 2017

A prisoner [a sex criminal, to be precise - CJS] suffering from poor health has lost his attempt to enforce
the smoking ban in English and Welsh jails after the supreme court
ruled that crown premises are effectively exempt from the enforcement of
health regulations.

The unanimous judgment from the UK’s highest court will prevent the
inmate, Paul Black, from calling the NHS’s smoke-free compliance line to
report breaches of the ban.

It will be interesting to see what this does to the government's plans to ban smoking in all prisons. The idea was to roll out the ban to the category B and C jails first because it was assumed that they would put up the least resistance. Maximum security category A prisons were supposed to have been covered by September 2017, but after smoking bans caused riots this summer in HMP Birmingham and HMP Haverigg (categories B and C respectively), we have heard no more about it.

And there's more...

Lady Hale, the president of the supreme court, said she was driven
with “considerable reluctance” to conclude that when parliament passed
the 2006 Health Act, prohibiting smoking in offices, bars and enclosed areas, it did not mean to extend it to government or crown sites.

The standard practice is that a statutory provision does not bind the
crown unless legislation adopts words explicitly stating so or by what
is known as “necessary implication”.

“Had parliament intended part 1 of chapter 1 of the 2006 act to bind
the crown, nothing would have been easier than to insert such a
provision,” Hale explained.

Yes, that really does mean what you think it means. The ban on smoking in public places doesn't actually apply to public places. It only applies to private places, as the sex offender's lawyer explains...

“This judgment has far wider implications than simply the issue of
smoking in prisons. It confirms that thousands of government properties,
including, for example, courts and jobcentres, are not covered by the
provisions of the Health Act prohibiting smoking in enclosed places.
While many of these buildings even have signs saying it is against the
law to smoke in them, these turn out to be incorrect.”

The women's figure is not too far off the lowest end of the Lancet estimate. One of the weird things about the estimates is that they consistently predict higher rates of obesity for men than for women, despite men having never had a higher rate of obesity ever since obesity started being measured properly in 1993.

As for childhood obesity, it continues to fail to 'spiral'. After falling from 17 per cent to 14 per cent last year, it ticked up to 16 per cent in this week's figures - the same as it was in 1999.

The rate of obesity among 11 to 15 year olds is an implausibly high 23 per cent. Why implausible? Because the rate among 16 to 24 year olds is only 10 per cent. Are we supposed to believe that most obese kids suddenly lose weight once they leave school?

In clinical practice, the 98th centile is considered to be a more appropriate cut-off. If you measure it from the 98th, you get less of a gap between the 11-15 year olds and the 16-24 year olds, and yet we persist with a measurement that is clearly wrong.

Monday, 18 December 2017

In September, I listed some of the cases of cigarette smuggling and illegal tobacco production that have been reported in the Australian media this year. The scale and frequency of these events is striking. Millions of cigarettes are being seized in a single raid. Tobacco crops worth $10 million or more are being found in the outback. Needless to say, the quantities seized are trivial compared to the quantities that get through.

Border
Force estimates nearly 15 per cent of all tobacco sold in Australia has
been illegally imported to avoid local taxes. And little wonder. The
price of cigarettes has doubled in the last six years, with a packet
expected to cost $40 in just over two years.

... The figures are staggering. Border Force have created Tobacco Strike Teams
that have in the last 12 months seized 96 million illegally imported
cigarettes from one organised crime group. In two years from 2015 they
have seized 400 tonnes of tobacco that would have evaded excise of $294
million. In the last financial year, the total was around 180 million
fags weighing 174 tonnes.

... In 2016-17, there were 190 cigarette-related armed robberies and more
than 450 commercial burglaries targeting the product. When you consider
the crooks can sell a stolen packet for $10 a pop, no questions asked,
you can see the profit margin is immense.

Australia's illicit trade runs the gamut of small time crooks, robbery,
industrial scale production, international smuggling rings and corrupt
officials. It's not hard to see why...

Let's look at the maths. If you were to invest $200,000 in cocaine,
you could expect a return of $1.6 million. Invest the same amount in
smuggled cigarettes from China and the return would be $10 million.

... The laws on plain packaging of cigarettes -
designed to strip the addictive product of any advertising gloss - have
made it difficult for police to link recovered stolen packets to the
source of the robbery, as the packs don't have identifiable registration
numbers.

Thursday, 14 December 2017

It's around this time of the year that the British Medical Journal publishes its annual spoof article to show that it's got a sense of humour. These parodies become harder to spot every year as the quality of its general output diminishes. This 'study' is a case in point.

As reported by the BBC and others, the BMJ has got into the Christmas spirit by moaning about the size of wine glasses. The lead author of the offending article is Theresa Marteau, a nanny state halfwit who ticked enough temperance boxes to be put on the alcohol guidelines committee.

Over the years, Marteau has somehow found a way of getting grant money to carry out worthless research into the size of wine glasses, fizzy drink bottles and tableware (see here, here, here and here for a small sample). She generally concludes that people eat/drink more from larger plates/glasses and, being a meddling ratbag with too much time on her hands, thinks that the government should do something about this.

The BMJ article is her latest attempt to rally doctors behind her mad campaign. After describing the Christmas period as 'the culturally legitimised deviancy of festive drinking', she offers a series of guesses and hunches about the 'population health' impact of large wine glasses .

Environmental cues such as the design of drinking glasses—particularly
their size—may also have contributed to increased drinking, particularly
of wine...

...plate sizes have increased over the past 100 years, likely contributing to the prevalence of obesity and overweight...

The amount of alcohol people drink, particularly wine, has increased sharply since the 1960s.
Along with lower prices, increased availability, and marketing, larger
wine glasses may have contributed to this rise through several
potentially co-occurring mechanisms.

...the amount of pure alcohol that wine drinkers consume has likely risen in line with larger glasses.

The only thing Marteau et al. are able to show convincingly is that wine glasses have got bigger in the last 300 hundreds.

According to this chart, the average size of a wine glass is currently 450ml and some wine glasses exceed 800ml.

Obviously, people are not putting a pint of wine in their glasses. If Marteau et al. spent a bit more time drinking wine and a bit less time worrying about it, they would know that drinkers prefer big glasses because it helps the wine breathe and releases the aroma.

Perhaps unwittingly, the BBC have used a picture of modern wine glasses which nicely illustrates typical servings.

There is a slight acknowledgement of the benefits of larger glasses when Marteau et al. say...

Larger wine glasses can also increase the pleasure from drinking wine...

To any reasonable person, that would be case closed. If it improves wellbeing, it should be encouraged. But Marteau et al. immediately follow this by saying...

RESULTS Wine drunk from
the larger, compared with the smaller glass, was consumed more slowly
and with shorter sip duration, counter to the hypothesised direction of
effect.

CONCLUSIONS These findings provide no support for the hypothesised mechanisms by which serving wine in larger wine glasses increases consumption.

You'd think peer review would pick things like this up, wouldn't you?

Having made the mundane observation that wine glasses have got bigger, they have to admit that...

We cannot infer that the increase in glass size and the rise in wine
consumption in England are causally linked. Nor can we infer that
reducing glass size would cut drinking.

But a total inability to demonstrate cause and effect is no reason not to legislate in the world of 'public health' and so they conclude that...

...regulating glass size as part of local licensing regulations would
expand the policy options for reducing drinking outside the home.

I can only assume that this means they want it to be illegal to sell wine in a glass that the government thinks is too big. The intention of this epic micromanagement of people's lives is, it seems, to denormalise large wine glasses...

Reducing wine glass sizes in licensed premises may also shift the social
norm of what a wine glass should look like, potentially influencing the
size of glasses people use at home—where most alcohol, including wine,
is drunk.

'What a wine glass should look like', FFS!

Encouraging [forcing? - CJS] wine producers and retailers to make non-premium bottles of
wine available in 50 cL and 37.5 cL sizes, with proportionate pricing,
may also encourage drinkers to downsize their wine glasses so that one
bottle fills more glasses.

Tuesday, 12 December 2017

Austria’s far-right Freedom party has announced that a planned ban on smoking in all bars and restaurants that was due to come into force in 2018 will be scrapped.

Party chief Heinz-Christian Strache said the reversal was agreed in ongoing talks to form a coalition with the conservative People’s party (OVP) following elections in October.

“I am proud of this excellent solution in the interests of non-smokers, smokers and restaurant owners,” Strache, who had made the move a key campaign pledge, said on social media.

“The freedom to choose lives on. The existence of restaurants (particularly small ones) has been secured. Thousands of threatened jobs have been saved,” said Strache, himself a smoker.

I don't know enough about Austrian politics to know whether the Freedom party are really on the 'far-right' or whether this is exaggeration by the Guardian. If they are then they have a considerably more enlightened view of smokers' rights than the last far right party that was in charge there.

...the
authors may well be the only people in the history of the planet who
have been to Italy and come back with a diet named after an Italian
village that excludes pasta, rice and bread – but includes coconuts –
perhaps because they have a low carb agenda. The suggestion that this
Italian village should be associated with recipes for cauliflower base
pizza and rice substitute made from grated cauliflower or anything made
using coconut oil is ridiculous. It also uses potentially dangerous
expressions like "clean meat" and encourages people to starve themselves
for 24 hours at a time every week... The traditional
Mediterranean diet is a healthy choice but this had been hijacked here.
Fasting may help weight loss but the only reason their other advice is
likely to help people lose weight is because it involves eating less
food and calories.

Malhotra has been in meltdown ever since, frantically retweeting every nutter who thinks that Big Grain is out to kill them. In the food faddist equivalent of the bat-signal, he sent out an urgent request for back up to every diet guru on Twitter.

By the time the BBC covered the story, he had settled on the excuse that dietitians are stooges of the food industry (or that part of the food industry that sells carbohydrates)...

"One has to question the financial links and influence of various
food companies on the BDA. In my view, they cannot be trusted as an
independent source of dietary advice."

Almost everybody in nutritional science has worked out that Malhotra is a fame hungry crackpot who should not be taken seriously (even Action On Sugar). In a sane world, his latest outburst would be enough to end his media career, but that may be too much to ask.

Thursday, 7 December 2017

A former UC San Francisco doctoral researcher Wednesday filed a
lawsuit alleging sexual harassment by a prominent tobacco control
activist and tenured UCSF professor Stanton Glantz that spanned nearly
two years.

The lawsuit also alleges that Glantz retaliated against his former
mentee, Eunice Neeley, after she complained about him to the
university’s administration by removing Neeley’s name from a research
paper.

Neeley accused Glantz of consistent inappropriate behavior that
included staring at her body, making comments directed at Neeley
referencing sex, making sexual remarks about other women to Neeley while
at the workplace, and making racist remarks about Neeley, who is black.

The UCSF Board of Regents is named as a defendant in the lawsuit
filed in San Francisco Superior Court for allegedly failing to take
action against Glantz after Neeley notified the university about the
harassment.

...According to Neeley’s lawyer, Kelly Armstrong, Glantz is a current
employee of UCSF. He rose to prominence for his research on the effects
of secondhand smoke on the heart, and has authored numerous
publications on secondhand smoke and tobacco control.

Neeley purports that Glantz used his tenure to intimidate his
students from reporting his sexual harassment and emotional abuse.
According to the lawsuit, Glantz was known to have told multiple
students that as a tenured professor, “You can rape the vice
chancellor’s daughter and still have a job.”

... The lawsuit alleges that the university was made aware of Glantz’s
misconduct but failed to “take meaningful action to protect Neeley and
other females from further sexual harassment.”

Armstrong said that Neeley wasn’t the only victim of Glantz’s misconduct.

“We believe there are multiple witnesses and victims to the sexual harassment by Glantz,” she said.

Saturday, 2 December 2017

In the post-truth world in which we supposedly live, the rise of professional fact-checkers is welcome. The BBC's More or Less is the pick of the bunch, but it's only 30 minutes on Radio 4 for a few months each year. Online, Full Fact does a great job of picking apart the numbers of the day.

Channel 4's FactCheck is less impressive but it can be useful when it isn't buckling to political activists (as it did last week when it changed the headline and website address of this article).

And then there is the BBC's Reality Check which is sort of a fact-checker, but also sort of a rough guide to the issues people are talking about. Its premise seems to be that it provides a cool-headed look at The Facts which you wouldn't get from the rest of the media (like, er, BBC News). Last night it put out an article which illustrates the potential for abuse when journalists set themselves up as arbiters of The Truth.

What does the research show? There's quite a lot of evidence that having fast food nearby leads to more obesity in adults.

I happen to be familiar with the research in this area. There is indeed a lot of evidence, but very little of it makes a convincing case that living near a fast food shop leads to more obesity in children or adults. But there is one particular UK study that campaigners often cite because it claims to have found a link - and that's the one that BBC Reality Check focuses on:

There is, for example, this research from Cambridge,
which found that people living closest to the largest number of
takeaway food outlets were more than twice as likely to be obese than of
normal weight.

This study concluded that: 'Exposure to takeaway food outlets in home, work, and commuting
environments combined was associated with marginally higher consumption
of takeaway food, greater body mass index, and greater odds of obesity.' But there is something rather interesting about it that was picked up by the statistician Jeremy Franklin. He noticed that:

After reading the interesting article by Burgoine et al. I was at
first irritated by the lack of a table to compare the characteristics
(as shown in Table 1) of participants grouped according to quarters of
take-away environment... Usually
one would expect such tables in order to assess the comparability of the
groups with respect to possible confounders and for a direct,
unadjusted comparison of outcomes, respectively.

Then I discovered this information in Web table 3 of the online
appendix. Here, we see systematic differences between quarters with
respect to education, smoking and car ownership...

What surprised me even more in Web table 3 was the fact that mean
take-away consumption was slightly inversely correlated with combined
take-away availability, varying between 36.3 g/day in Q1 and 34.2 g/day
in Q4. This contrasts completely with the results of the multivariate
analysis (Fig. 1) in which a significant positive correlation between
take-away availability and consumption was obtained. Moreover, In Web
table 3 mean BMI is almost constant in all quarters of take-away
availability, contrasting with the significant positive correlation
between take-away availability and BMI derived from the multiple linear
model (Fig. 2).

In other words, there was no difference in obesity rates between those who lived near fast food outlets and those who didn't. Moreover, the people who lived near them actually consumed slightly less takeaway food. Here's the data that was tucked away in a supplementary file:

The findings presented by the authors are entirely the result of changes they made to the data in their attempt to control for other variables.

Perhaps some of these adjustments were appropriate, but we are required to put a lot of faith in the researchers before we accept their conclusion. And their conclusion is really that obesity rates are not actually higher near takeaways but they would be were it not for confounding factors.

A further point of interest is that the study included supermarkets as a source of takeaway food. When the authors excluded supermarkets in their sensitivity analysis, they were unable to find any association with between takeaway food and obesity, even after adjusting the data. They admitted that excluding supermarkets meant that 'the associations between combined take-away food outlet exposure,
consumption of take-away food and body mass index were attenuated
towards the null’.

As Franklin says, 'The expression "attenuated towards the null" is an
understatement: no association remains at all, in agreement with the
simple univariate comparison.'

The Cambridge study is therefore hardly the most compelling evidence that having fast food nearby leads to more obesity.

But the Reality Checkers have two other pieces of evidence to make the case. The first is a survey conducted by Brent council, asking secondary school pupils how far they would be prepared to walk to a fast food shop. It didn't included any measure of obesity or health and, as the BBC acknowledges, 'the differences between the likelihood of children having lunch from a
takeaway outlet if they attend a school close to one or further away
from one were fairly small and the results were skewed by most of the
children surveyed not actually being allowed off-site at lunchtimes.'

Finally, there is this:

Another report on the subject found that the food available near schools did have some effect on pupils' choices but that it was only a small effect.

That's putting it mildly. The association between proximity to takeaways and an 'unhealthy diet' was tiny (0.003, 95%CI 0.001
–
0.006) and the study didn't even attempt to find an association with obesity.

So much for there being 'quite a lot of evidence that having fast food nearby leads to more obesity'. The most revealing thing about the BBC article is not how weak the evidence it cites is, but the failure to mention all the other evidence.

For example, this study found that 'obesity prevalence was highly significantly negativelyrelated to the densities of both FFRs [fast food restaurants] and
FSRs [full service restaurants]' and this study found that 'away from home food expenditures negatively
affect BMI and that BMI is negatively related to the percentage of the food
budget spent away from home'.This study from the UK found that fast food consumption was negatively associated with obesity (ie. those who eat it most often have the lowest body mass). Although the authors made significant adjustments to the data, they were not able to find a positive association. The raw data is shown below.

This US study concluded that 'Proximity of "fast food" restaurants to home or work was not associated with eating at "fast food" restaurants or with BMI' and this US study found 'no association between child overweight and proximity to playgrounds, proximity to fast food restaurants, or level of neighborhood crime.'

And this study from the UK didn't find an association between takeaway outlet density and obesity except among 'the least educated'.

The evidence that living near a takeaway (or near lots of takeaways) is not at all strong. It is mixed and conflicting, with many results supporting the null hypothesis. In their literature review of 2010, Fraser et al. found that...

... of the 12 cross-sectional studies which looked at FF [fast food] outlets
in relation to overweight or obesity, six found a significant positive
association, two had significant negative results and five showed no association.
Of the studies which showed a positive association between FF outlets
and weight/BMI, one only found an association in non-car owners, one found an association in adult females only,
one found a significant association between increased number of FF
outlets and increased obesity but also decreased obesity if closer to a
FF outlet, and one found an association between weight status and FF exposure in schools. The other study with a positive result
aggregated their individual level data to perform a county level
analysis. All six of these studies used self-reported heights and
weights to calculate BMI. The longitudinal study found no association
between density of FF outlets and BMI change in children.

Faced with this murky picture, BBC Reality Check chooses to simply assert that there is 'quite a lot of evidence that having fast food nearby leads to more obesity in adults' and the quotes Prof Naveed Sattar from Glasgow University who offers the kind of opinion you'd get from a bloke in a pub.

"When I was a child we had a fish and chip shop about 200m from my
school and lots of us went there - if it had been a bit further away
maybe they wouldn't have bothered.

"It's pretty obvious that if you make things easy people will gravitate towards them."

Friday, 1 December 2017

Today is the fifth anniversary of plain packaging in Australia. If you're a regular reader of this blog, you'll be aware that it was a flop. I've written an article for City AM picking at the scab of this policy because it is important to audit 'public health' measures to see if they fulfil the promises that their advocates make for them. They rarely do.

No one has does more to expose the junk science used to justify plain packaging in Australia than the economist Sinclair Davidson. He has made a short video showing the various tactics used to torture the data. It's well worth a watch...

Sinclair was in the UK earlier this year and I invited him to the IEA to share his findings. You can see a video of that here.

... "It will simply wipe out the bottom end of the market and force
consumers who have a preference for budget brands to buy mid-range
brands," said Chris Snowdon, the IEA's head of lifestyle economics.

"It
is likely to lead to a shift from cider to spirits for dependent
drinkers. A shift to the cheapest illegal drugs is also highly plausible
among some groups, including young people."

He also claimed it could increase the cost of living for those who do
not wish to drink less and is likely to lead to those on low incomes
cutting other parts of the household budget, such as food and heating.

The committee generally seemed to be sceptical about the idea that increasing the price of most off-trade booze was only going to cost moderate drinkers two quid a year (as the Sheffield lot claim). And rightly so, it would be a very unusual drinker who was affected so little. One of their number was less sure about alcohol and drugs being substitutes (a 'public health' trougher had denied this in an earlier session). I promised to forward some evidence and have now done so, including this, this, this and this.

Tuesday, 28 November 2017

The major of London, Sadiq Khan, is the latest gullible chump to fall for an idiotic idea from 'public health' busybodies.

Fast-food takeaways will be banned from opening within 400 metres of
schools in a bid to tackle the capital’s child obesity epidemic.

... [Khan] said: “Takeaway restaurants are a vibrant part of London life, but
it’s important that they are not encouraging our children to make poor
food choices.

“I am using all of my powers through my new London Plan to prevent
new takeaways from being built just down the road from schools as part
of a package of measures to tackle the ticking time bomb of childhood
obesity and help us all lead healthier lives.”

Great news for the incumbent chicken shop industry, not such good news for consumers. When did protecting existing fast food outlets from competition become part of the mayor's job?

But the ban only applies to streets within 400 metres of a school, right? How bad can it be?

That map doesn't show the scale so let's zoom in on one area at random and compare it with a Google map of the same area which shows what 500 metres is in the bottom right.

Imagine a 400 metres exclusion zone around each of those schools and you get an idea of how far-reaching this ban is.

And thanks to some solid work by Dan Cookson, you don't need to use your imagination. Here's how it will look...

In the future, if you want to open a Chinese takeaway or a sandwich shop in a part of London where people actually live - ie. not in a river or a park - you might as well forget it. In the future, a licence to sell tasty food will be like gold dust. The only way to get one will be to beg, borrow or steal from one of today's lucky owners.

Monday, 27 November 2017

The statistician David Spiegelhalter gave a speech to the Public Health England conference in September. You can see it on Youtube. His main point is that the health lobby could do a much better job of communicating risk. In his polite and cheerful way, he gently alludes the fact that many in 'public health' do not want to communicate risk properly. Instead they want to communicate risk in a scary way because their objective is not to have an informed population. It is to have a compliant population.

Of particular interest is Spiegelhalter's discussion of the drinking guidelines. He skips over the problems with the Sheffield model (although he was partially aware of the effect that changing the methodology had) and focuses on the way the 'evidence' was reported to the public. He mainly blames the government's communications people, thereby overlooking the role of the guidelines committee and Sally Davies herself, but he rightly says that the communication of drinking risk was very miselading.

Friday, 24 November 2017

At the end of last month, I revealed the e-mails that show Public Health England telling the Sheffield Alcohol Research Group to change the methodology of their computer model despite the obvious reservations of the latter. The change in methodology had no sound scientific justification but it had the effect of lowering the model's implied drinking guidelines for men from around 21 units to around 13 units. The Chief Medical Officer subsequently announced that the male drinking guidelines would be reduced from 21 units to 14 units.

Public Health England's Duncan Selbie has since written a letter to the Spectator in which he disclaims responsibility for this and gives the credit/blame to the guidelines group. I reproduce it below, along with my response.

Christopher Snowdon’s piece, ‘The new drinking guidelines are based on massaged evidence’, is grossly incorrect and misrepresents Public Health England’s (PHE) role in the guidelines’ development.

PHE emphatically refutes any suggestion that we intervened in some way to influence the evidence made available by Sheffield University to an independent expert group, the Guideline Development Group (GDG), which was set up by the UK Chief Medical Officers to help develop the alcohol guidelines.

As part of the secretariat to the group, we commissioned the analysis, as requested by the GDG, from Sheffield University. Any emails from PHE to Sheffield commissioning additional modelling and evidence were based on the GDG’s decisions and at their request, as is clearly shown by the publicly available minutes of their meetings.

This has been confirmed by Sheffield University’s Alcohol Research Group, which has said:

“Minutes from the subsequent GDG meeting on 21 January 2015 state that, after hearing Sheffield’s presentation of their work, the GDG concluded: ‘A holistic, expert judgement on guideline levels would be needed, taking account of uncertainties and issues not fully modelled’. This demonstrates that the group recognised there was considerable scientific uncertainty present and that no single piece of evidence or modelling decision used in isolation would determine the final guideline.

“As noted in the Royal Statistical Society’s consultation response: “This is a contested area of science with considerable uncertainties” (paragraph 1.1). The change to the base case analyses related to a point of scientific uncertainty. The Sheffield Alcohol Research Group were happy with the decision taken whereby the base case analysis was revised but the original modelling assumptions were retained as one of a series of sensitivity analyses.

“Those analyses explored major areas of uncertainty within the underlying evidence and their implications for the Guideline Development Group’s work. The group considered those sensitivity analyses in detail and took them into account in their decision-making.”

Mr Snowden [sic] also refers to The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies: An evidence review, which PHE published in 2016. The facts speak for themselves; this unprecedented and comprehensive evaluation of the evidence had an extensive three-stage peer-review involving UK and international academics. The abridged version was also subject to further peer-review processes before its publication by The Lancet.

My reply:

If, as Public Health England claims, my exposé of the alcohol guidelines review was 'grossly inaccurate', one would expect the agency to flag up some factual errors. Their sole complaint appears to be that I suggested that it was they, rather than the Guideline Development Group, who came up with the idea of changing the methodology. I suggested no such thing. I explicitly said in the original article:

"On 21 January, the GDG held a meeting at which SARG’s John Holmes and Colin Angus presented their findings. The
minutes of this meeting contain the first mention of an idea that would
have a profound impact on the whole project. It was suggested that SARG
researchers should ‘estimate risk curves without threshold effects for
wholly alcohol-attributable chronic conditions’."

As the commissioner of the research, PHE followed up with a series of e-mails to the Sheffield Alcohol Research Group (SARG) in February 2015. These e-mails show the Sheffield researchers trying to talk PHE out of the idea of replacing their base case scenario with a sensitivity analysis that was built on patently unrealistic assumptions.

The crucial e-mail exchange came on 10 February when SARG said that they were 'unclear exactly what was being requested' and that 'it does not seem right to assign people drinking at very low levels a risk of acquiring alcoholic liver disease and similar conditions.' They added that: 'Unless there are strong opposing views, we think it better to keep the threshold in the base case.'

That e-mail was sent at 4.37pm. PHE replied at 10.40pm with a short
e-mail ignoring the compromise suggested by the Sheffield team and
asking how much it would cost to drop the threshold from their main
findings (the 'base case'). From this, there was no looking back.

It is also possible that the GDG had explicitly ordered the base case to be changed in its meeting of 21 January. If so, it was not recorded in the minutes. The minutes merely state that the GDG had suggested that PHE 'commission further sensitivity analyses or new modelling where feasible' including an estimate of 'risk curves without threshold effects for wholly alcohol-attributable chronic conditions'. As I explained in my article, there is a huge difference between running a sensitivity analysis and changing the base case that will dictate the headline findings.

The reaction of the Sheffield researchers to PHE's request for a change in methodology suggests that such a fundamental change was not agreed at the GDG meeting. Two of the Sheffield team were at that meeting. If the GDG had explicitly called for the base case to be changed, why were they so surprised and dismayed when PHE asked them to do it?

We will probably never know what was going on between PHE and members of the GDG behind the scenes. PHE's complaint against me seems to be that I gave the impression that the agency somehow overrode the will of the GDG. I don't think any fair-minded reader would infer that from my article but, for the avoidance of doubt, let me say again that the GDG was packed with campaigners from the temperance and 'public health' lobby who would have been delighted to see the guidelines lowered. There is enough blame and shame to be shared by all three of the groups involved: the guidelines committee, Public Health England and the Sheffield Alcohol Research Group. I have never suggested that PHE bear all, of even most, of the responsibility.

The fact remains, however, that Public Health England commissioned and funded the Sheffield research and it was they who set the parameters, whether acting as intermediaries or on their own initiative. Having funded the research, they now seem keen to pass the buck to the GDG. For their part, the Sheffield team has always been keen to pass the buck to PHE. Twice in their report, SARG stress that the dropping of thresholds was done at the agency's request. On page 28 they say: 'At the request of the commissioners (Public Health England), this threshold effect removed for the base case analysis...' Note that they do not say that it was done at the request of the GDG. Elsewhere in the report they make it clear that they would not normally run their model in the way they did and, at times, they seem to be distancing themselves from their own findings.

If this research was so strong, why does nobody want to take responsibility for it? Why is PHE so keen to point the finger at the GDG? Why is SARG so keen to play down the importance of their report? It is not a good look for PHE to be saying that they were only following orders. The best defence the Sheffield team has been able to mount is to claim that the change in methodology related to 'a point of scientific uncertainty' and that they were 'happy with the decision taken'. Anyone who reads the e-mails can be the judge of how 'happy' they were about it, but there is really no 'scientific uncertainty' about whether moderate drinkers are at an increased risk of developing diseases of alcoholism. They are not. There is plenty of uncertainty about how much an individual needs to drink before the benefits of alcohol are outweighed by the risks, but there is no uncertainty about there being a threshold for the ten chronic diseases that SARG dropped 'at the request of the commissioners'.

SARG are keen to point out that the change in the guidelines was not due to any single piece of evidence. I have never suggested otherwise, but their report cannot be dismissed as unimportant. It was explicitly designed 'to inform the Chief Medical Officer's review of the UK low risk drinking guidelines', as its title says. The first draft noted that the 'implied guideline thresholds are generally similar to those in the current UK lower drinking guidelines’. An anonymous reviewer of that draft wrote: 'I predict that there will be very little, if any, change to the Guidelines'. That all changed once PHE got SARG to change their methodology. It would have been possible to lower the guidelines without changing the Sheffield model, but it would have been a hard sell. The credibility of Sheffield's work is therefore of significant public interest. Is there anybody willing to stand up for it?

PHE defends its 2016 alcohol policy report on the basis that it was peer-reviewed. Peer review can make a document fit for publication but it does not make it true. If the aim of peer review is to fact-check, PHE was let down by its reviewers on that occasion. The 2016 report contains numerous basic errors, such as the claim that ‘real-term alcohol prices have decreased’ since 1980 (they have risen by 23 per cent). The report was released to the public with the claim that people in Britain are drinking twice as much as we did in 1980. We are actually drinking exactly the same amount (9.4 litres per adult). 'The facts speak for themselves', says Mr Selbie. Indeed they do, if you can find them.

When a report is littered with obvious errors, defending it on the basis that it has been peer reviewed is more of an indictment of your peer review process than a defence of the publication. But I am glad they have brought it up since it allows me to mention something about the guidelines process that space did not permit in my original article.

When I have had work peer reviewed at the Institute of Economic Affairs and elsewhere, the editor gives the manuscript to a third party of his or her choosing who doesn't know that I wrote it. When I receive their comments I don't know who they are. This double-blind system prevents any bias towards or against the author. By convention, reviewers are not paid.

This is not how it worked when the Sheffield team submitted their final report. On 6 May 2015, PHE sent an e-mail asking if they had had it externally peer reviewed. Sheffield said that they hadn't but they were 'happy to arrange for this to happen'. On 12 June - more than a month later - someone from PHE replied to say that 'I'm happy for you to suggest reviewers'. Sheffield then provided two names (which are redacted in the e-mails released under FOI) and asked PHE: 'Do you want the reviews to come through you or are you happy for us to just share the comments and revisions?' PHE replied: 'Happy for you to sort out the peer review directly and share comments/revisions with me.'

On 25 June, Sheffield e-mailed PHE saying that they had approached two potential reviewers, one of whom wanted £650 to do it because 'this is the rate he is being paid by PHE to review another lengthy report'. PHE said that they 'don't have any funds set aside for peer review' but were 'looking into' whether they could access some.

By mid-September, no funds had been released and only one reviewer had been found - an unnamed PHE employee. SARG e-mailed to say that 'I think we're just looking at XXX(PHE) unless you would like me to try to find someone else at short notice?' It is not clear from the released e-mails whether a second person was ever found. All we know for sure is that PHE handed the task of finding reviewers for the SARG report to the people at SARG who then approached somebody at PHE to do it! This is a far cry from blind external peer review.

Finally, Mr Selbie quotes SARG quoting the Royal Statistical Society and their reference to a 'contested area of science'. SARG say that the 'change to the base case analyses related to a point of scientific uncertainty'. This is misleading. The contested area of science to which the Royal Statistical Society referred was the general issue of defining a low-risk guideline, which is indeed difficult to pinpoint with precision. They were not referring to the specific question of whether there is a consumption threshold for some diseases.

SARG did not quote what the Royal Statistical Society actually said about that question. On page two of their consultation response, the Society notes that getting rid of the threshold leads to a 'statistically implausible
assumption of a linear relationship' and that 'without this enforced assumption, the threshold for males to reach a 1% lifetime risk would have been 21
rather than 14 units, exactly the previous Guideline'.

About Me

Writer and researcher at the Institute of Economic Affairs. Blogging in a personal capacity.
Author of Selfishness, Greed and Capitalism (2015), The Art of Suppression (2011), The Spirit Level Delusion (2010) and Velvet Glove, Iron Fist (2009).

"Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."